Multimodal imaging in the diagnosis of bone giant cell tumors:A retrospective study

BACKGROUND Giant cell tumor of bone is a locally aggressive and rarely metastasizing tumor,and also a potential malignant tumor that may develop into a primary malignant giant cell tumor.AIM To evaluate the role of multimodal imaging in the diagnosis of giant cell tumors of bone.METHODS The data of 32 patients with giant cell tumor of bone confirmed by core-needle biopsy or surgical pathology at our hospital between March 2018 and March 2023 were retrospectively selected.All the patients with giant cell tumors of the bone were examined by X-ray,computed tomography(CT)and magnetic resonance imaging(MRI),and 7 of them were examined by positron emission tomography(PET)-CT.RESULTS X-ray imaging can provide overall information on giant cell tumor lesions.CT and MRI can reveal the characteristics of the internal structure of the tumor as well as the adjacent relationships of the tumor,and these methods have unique advantages for diagnosing tumors and determining the scope of surgery.PET-CT can detect small lesions and is highly valuable for identifying benign and malignant tumors to aid in the early diagnosis of metastasis.CONCLUSION Multimodal imaging plays an important role in the diagnosis of giant cell tumor of bone and can provide a reference for the treatment of giant cell tumors.

Soft tissue recurrence of giant cell tumor of bone: A report of two cases and literature review

We investigated the clinical features of soft-tissue recurrence in giant cell tumor of bone （GCTB）. Among 106 cases with GCTB in our hospital, there were 2 cases occurring soft-tissue recurrence which histories were reported. These two soft-tissue recurrences occurred with the interval of 6.9 years and 2.5 years respectively from pdmary diagnosis. The clinical presentation was nonspecific masses in soft tissue. Radiographic ossification was not found at periphery or within the masses. Through pathological examination peripheral ossification was found in 1 case and malignant transformation occurred in the other case. Through retrieving and reviewing literatures in PubMed, 19 cases of soft-tissue recurrence with detailed materials were collected and analyzed. Soft-tissue recurrence of GCTB is a rare episode which reflects its locally aggressive nature, the reasons of which are tumor cells implantation and tumor residual. Ossification at periphery or in the masses can be considered as a pathognomonic character of this episode in radiographic and pathohistological examination. The prevention lies in determining tumor extension preoperatively, proper non-tumor manipulations, removing the tumor and irrigating operative wound as completely as possible.

Autograft-prosthesis composite for aggressive giant cell tumor of bone around knee

Objective： The aim of the research was to study the clinical feasibility of autograft-prosthesis composite for aggressive giant call tumor of bone around knee. Methods： Seven patients （5 males and 2 females, the mean age of 30.5 years old） with giant cell tumor of bone around knee underwent tumor resection and reconstructed with autograft-prosthesis composites since January 2006. Five lesions located at the distal femur and 2 at the proximal tibia. There were 3 patients with primary tumor and 4 with recurrent. Three patients with pathological fracture and all patients were of Campanacci Ⅲ. Results： All patients were done follow-up from 12 to 36 months. No recurrence, metastasis, and prosthesis loosening were found. The mean healing time between autograft and host bone was 5 months. The mean motion range of affected knee were 90° （70°-110°）. Conclusion： Our data documented the clinical feasibility of autograft-prosthesis composite for giant cell tumor of bone around knee which should be performed tumor resection and reconstructed with prosthesis. The long-term outcomes remain to be further proven.

Primary Malignant Giant Cell Tumor of Bone:A Case Report

Primary malignant giant cell tumor of bone is clinically rare,lack of specificity,and often misdiagnosed.Currently,related literature about this tumor remains scarce.One case of primary malignant giant cell tumor of bone was diagnosed and treated in our hospital,and the treatment effect was satisfactory.There was no recurrence or metastasis in 2 years of followup.The report is as follows.

Three-dimensional-printed custom-made patellar endoprosthesis for recurrent giant cell tumor of the patella:A case report and review of the literature

BACKGROUND Giant cell tumor(GCT)is a benign lesion and rarely involves the patella.This disease is characterized by a relatively high recurrence rate after primary treatment.En bloc resection has been a predominant option for recurrent GCT.However,total patellectomy can lead to disruption of the knee.Therefore,exploration of functional reconstruction of the extensor mechanism is worthwhile.CASE SUMMARY A 54-year-old woman presented with right knee pain and swelling,and was diagnosed as having a GCT in the patella following curettage and autograft.Medical imaging revealed a lytic and expanded lesion involving the whole patella with focal cortical breaches and pathological fracture.Based on the combination of histological,radiological,and clinical features,a diagnosis of recurrent GCT in the patella was made(Campanacci grade III).After a multidisciplinary team discussion,three-dimensional(3D)-printed custom-made patellar endoprosthesis was performed following en bloc resection for reconstructing the extensor mechanism.The patient was followed for 35 mo postoperatively.No evidence of local recurrence,pulmonary metastasis,or osteoarthritis of the right knee was observed.The active flexion arc was 0°-120°,and no extension lag was detected.A favorable patellar tracking and height(Insall-Salvati ratio 0.93)were detected by radiography.CONCLUSION We depict a case of a GCT at the right patella,which was successfully treated by patellectomy and 3D-printed custom-made endoprosthetic replacement.The patella normal reconstruction,the precise-fit articular design,and gastrocnemius flap augmentation could lead to satisfactory knee function and a low rate of complications in the short-term follow-up.

Effect of cytokines on in vitro bone resorption by cells isolated from giant cell tumor of bone

Objective To investigate the effect of cytokines on in vitro bone resor ption by cells isolated from giant cell tumor of bone.Methods Mononuclear stromal cells and multinucleated giant cells (MGC) were isolated from 11 cases of giant cell tumor of bone (GCT) and their bone res orption capability in an in vitro cell bone resorption model were tested. Expre ssions of some cytokines were detected by immunohistochemisty, Western blotting analysis and Enzyme linked immunoabsorbent assay (ELISA) in the GCT.Results The results showed that MGCs of GCT had capability to resorb bo ne matrix directly. Fibroblast like stromal cells (FC) could not only resorb bo ne matrix directly, but also secret unknown factors to facilitate bone resorptio n of MGC. Exogenous TNF α could significantly increase the bone resorption by both kinds of stromal cells, while exogenous IL 1 did not. Expression rate of M CSF and level of TNF α in GCT were higher than in osteosarcoma and normal se rum.Conclusions The characteristic bone resorption behavior of GCT might be caused by its three major cell components. The M CSF and TNF α could promote their bone resorption capability.

Gene expression disparity in giant cell tumor of bone

The aim of this paper was to study the differential gene expression of giant cell tumor of bone(GCTB)by gene chip technology.Total RNA of 8 fresh GCTB specimens(Jaffe I∶6 cases,II∶1 case,III∶1 case;Campanacci I∶6 cases,II∶1 case,III∶1 case;Enneking Staging G0T1-2M0,5 cases,G1T1-2M0:2 cases,G1T2M0:1 case)and 4 normal bony callus specimens(the control group)were extracted and purified to get mRNA and then reverse transcribed to complementary DNA,respectively.Microarray screening with a set of 8064 human cDNA genes was conducted to analyze the difference among the samples and the control.The hybridization signals were scanned.The gene expression disparity between the GCTB samples and normal bony callus was significantly different(P<0.01),and the disparity of over 5-fold was found in 47 genes in the GCTB specimens,with 25 genes up-regulated and 22 down-regulated including the extracellular matrix and transforming-related genes,oncogene and its homolog genes,cytokine and its receptor genes.Specific gene spectrum associated with GCTB can be identified by cDNA microarray,which will be the foundation of progressive etiology elucidation,diagnosis and treatment of GCTB.

Bioactive glass selectively promotes cytotoxicity towards giant cell tumor of bone derived neoplastic stromal cells and induces MAPK signalling dependent autophagy

Giant cell tumors of bone(GCTB)are associated with massive bone destructions and high recurrence rates.In a previous study,we observed cytotoxic effects of three different compositions of bioactive glasses(BGs)towards GCTSC but not bone marrow derived stromal cells(BMSC)indicating that BGs represent promising candidates for the development of new therapeutic approaches.In the current study we aimed to investigate the molecular mechanisms that are involved in BG induced cytotoxicity.We observed,that BG treatment was not associated with any signs of apoptosis,but rather led to a strong induction of mitogen activated protein kinases(MAPK)and,as a consequence,upregulation of several transcription factors specifically in GCTSC.Genome wide gene expression profiling further revealed a set of fifteen genes that were exclusively induced in GCTSC or induced significantly stronger in GCTSC compared to BMSC.BG treatment further induced autophagy that was significantly more pronounced in GCTSC compared to BMSC and could be inhibited by MAPK inhibitors.Together with the known osteogenic properties of BGs our findings support the suitability of BGs as therapeutic agents for the treatment of GCTB.However,these data have to be verified under in vivo conditions.

Integrating coaxial electrospinning and 3D printing technologies for the development of biphasic porous scaffolds enabling spatiotemporal control in tumor ablation and osteochondral regeneration

The osteochondral defects(OCDs)resulting from the treatment of giant cell tumors of bone(GCTB)often present two challenges for clinicians:tumor residue leading to local recurrence and non-healing of OCDs.Therefore,this study focuses on developing a double-layer PGPC-PGPH scaffold using shell-core structure nanofibers to achieve“spatiotemporal control”for treating OCDs caused by GCTB.It addresses two key challenges:eliminating tumor residue after local excision and stimulating osteochondral regeneration in non-healing OCD cases.With a shell layer of protoporphyrin IX(PpIX)/gelatin(GT)and inner cores containing chondroitin sulfate(CS)/poly(lactic-co-glycolic acid)(PLGA)or hydroxyapatite(HA)/PLGA,coaxial electrospinning technology was used to create shell-core structured PpIX/GT-CS/PLGA and PpIX/GT-HA/PLGA nanofibers.These nanofibers were shattered into nano-scaled short fibers,and then combined with polyethylene oxide and hyaluronan to formulate distinct 3D printing inks.The upper layer consists of PpIX/GT-CS/PLGA ink,and the lower layer is made from PpIX/GT-HA/PLGA ink,allowing for the creation of a double-layer PGPC-PGPH scaffold using 3D printing technique.After GCTB lesion removal,the PGPC-PGPH scaffold is surgically implanted into the OCDs.The sonosensitizer PpIX in the shell layer undergoes sonodynamic therapy to selectively damage GCTB tissue,effectively eradicating residual tumors.Subsequently,the thermal effect of sonodynamic therapy accelerates the shell degradation and release of CS and HA within the core layer,promoting stem cell differentiation into cartilage and bone tissues at the OCD site in the correct anatomical position.This innovative scaffold provides temporal control for anti-tumor treatment followed by tissue repair and spatial control for precise osteochondral regeneration.

Hypercalcaemia after treatment with denosumab in children:bisphosphonates as an option for therapy and prevention?

Background Pharmacologic options for treatment of osteolytic diseases especially in children are limited.Although not licensed for use,denosumab,a fully humanized antibody to RANKL,is used in children with good effects.Among others,one possible indication are giant cell tumors and aneurysmatic bone cysts.However,there are reports of severe hypercalcemia during weeks to months after termination of denosumab,that are rarely seen in adults.Methods We collected data of four patients,aged 6-17 years,who experienced severe hypercalcemia after completion of treatment with denosumab for unresectable giant cell tumors of bone or aneurysmal bone cysts and methods of their treatment.The detailed case information were described.Results One patient was treated with long-term,high-dose steroid therapy,leading to typical Cushing's syndrome.Another patient was restarted on denosumab repeatedly due to relapses of hypercalcemia after every stop.Finally,in two patients,hypercalcemia ceased definitely after treatment with bisphosphonates.However,several applications were necessary to stabilize calcium levels.Conclusions There is a considerable risk of hypercalcemia as an adverse effect after denosumab treatment in children.Therapeutic and,preferably,preventive strategies are needed.Bisphosphonates seem to be an option for both,but effective proceedings still remain to be established.